Abstract Half of patients with colorectal cancer face liver metastasis. Tactically different approaches to the treatment of hepatic metastases, including using minimally invasive surgical techniques, have proven their effectiveness in improving oncological results. The correct choice of surgical treatment method depending on the number, localization, size of metastases, and their response to chemotherapy plays a crucial role in the further risks of disease progression. Liver resection is the standard of surgical treatment. If for some reason it is impossible to perform it, then the choice of the method of surgical treatment is performed among various methods of ablation and radiation therapy. The possibilities of intra-arterial chemotherapy, chemoembolization, and radioembolization are realized with chemoresistance and unresectability of foci for all types of surgery.
{"title":"Management of Patients with Synchronous Liver Colorectal Cancer Metastasis","authors":"A. Sidorova, O. Melekhina, B. Bashankaev","doi":"10.1055/s-0042-1760426","DOIUrl":"https://doi.org/10.1055/s-0042-1760426","url":null,"abstract":"Abstract Half of patients with colorectal cancer face liver metastasis. Tactically different approaches to the treatment of hepatic metastases, including using minimally invasive surgical techniques, have proven their effectiveness in improving oncological results. The correct choice of surgical treatment method depending on the number, localization, size of metastases, and their response to chemotherapy plays a crucial role in the further risks of disease progression. Liver resection is the standard of surgical treatment. If for some reason it is impossible to perform it, then the choice of the method of surgical treatment is performed among various methods of ablation and radiation therapy. The possibilities of intra-arterial chemotherapy, chemoembolization, and radioembolization are realized with chemoresistance and unresectability of foci for all types of surgery.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"54 1","pages":"042 - 050"},"PeriodicalIF":0.0,"publicationDate":"2022-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85749179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Befera, B. Cline, Jonathan G. Martin, P. Suhocki, Charles Y. Kim
Abstract Biliary obstruction is a common indication for referral to interventional radiology, particularly when endoscopic retrograde cholangiopancreatography has failed or is not possible due to postsurgical anatomy. The standard approach to percutaneous transhepatic biliary drainage involves gaining needle access to a peripheral bile duct, followed by advancement of a guidewire and drainage catheter across the obstruction and into bowel to allow internal drainage. While most cases of biliary obstruction are managed successfully with this conventional approach, in some situations it is not possible to traverse the occlusion with a guidewire and catheter, and thus advanced techniques may be required. This article has reviewed the available strategies for managing the impassable biliary obstruction.
{"title":"Tips and Techniques for Traversing the Impassable Biliary Stricture","authors":"N. Befera, B. Cline, Jonathan G. Martin, P. Suhocki, Charles Y. Kim","doi":"10.1055/s-0042-1757324","DOIUrl":"https://doi.org/10.1055/s-0042-1757324","url":null,"abstract":"Abstract Biliary obstruction is a common indication for referral to interventional radiology, particularly when endoscopic retrograde cholangiopancreatography has failed or is not possible due to postsurgical anatomy. The standard approach to percutaneous transhepatic biliary drainage involves gaining needle access to a peripheral bile duct, followed by advancement of a guidewire and drainage catheter across the obstruction and into bowel to allow internal drainage. While most cases of biliary obstruction are managed successfully with this conventional approach, in some situations it is not possible to traverse the occlusion with a guidewire and catheter, and thus advanced techniques may be required. This article has reviewed the available strategies for managing the impassable biliary obstruction.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"20 1","pages":"071 - 078"},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77688063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Sobh, M. Abdalbary, Mostafa Abdelsalam, Amr El-Husseini Mohamed
Liver cirrhosis is a major health problem that can affect people of different ages. It induces pivotal hemodynamic and metabolic systemic disturbances along with other organs dysfunction. Renal dysfunction in cirrhotic patients is not uncommon, and subtle renal impairment is an early and very frequent finding. Liver cirrhosis can afflict kidney functions through different mechanisms. Renal vasoconstriction is usually the initial response of splanchnic vasodilation and decreased effective renal plasma flow. This induces a reduction of intraglomerular pressure leading to stimulation of renin-angiotensin system to maintain the glomerular filtration rate. Other causes of renal dysfunction include electrolytes and acid-base disturbances, systemic inflammation, bile cast nephropathy, and intra-abdominal hypertension. Loss of renal reserve is usually the earliest manifestation of kidney dysfunction in cirrhotic patients. This makes the kidney supersensitive to any subsequent hemodynamic or metabolic abnormalities. Proper assessment of kidney function is one of the major challenges in cirrhotic patients. The use of serum creatinine and creatinine-based equations is inaccurate and can overestimate kidney function. Hepato-renal syndrome (HRS) is a life-threatening disorder. In the last decade, there was significant progress in understanding the mechanism of this mysterious disorder. In this article, we are focusing on different mechanisms of kidney dysfunction in cirrhotic patients and the major diagnostic and therapeutic challenges.
{"title":"Renal Dysfunction in Patients with Liver Cirrhosis","authors":"M. Sobh, M. Abdalbary, Mostafa Abdelsalam, Amr El-Husseini Mohamed","doi":"10.1055/s-0042-1746192","DOIUrl":"https://doi.org/10.1055/s-0042-1746192","url":null,"abstract":"Liver cirrhosis is a major health problem that can affect people of different ages. It induces pivotal hemodynamic and metabolic systemic disturbances along with other organs dysfunction. Renal dysfunction in cirrhotic patients is not uncommon, and subtle renal impairment is an early and very frequent finding. Liver cirrhosis can afflict kidney functions through different mechanisms. Renal vasoconstriction is usually the initial response of splanchnic vasodilation and decreased effective renal plasma flow. This induces a reduction of intraglomerular pressure leading to stimulation of renin-angiotensin system to maintain the glomerular filtration rate. Other causes of renal dysfunction include electrolytes and acid-base disturbances, systemic inflammation, bile cast nephropathy, and intra-abdominal hypertension. Loss of renal reserve is usually the earliest manifestation of kidney dysfunction in cirrhotic patients. This makes the kidney supersensitive to any subsequent hemodynamic or metabolic abnormalities. Proper assessment of kidney function is one of the major challenges in cirrhotic patients. The use of serum creatinine and creatinine-based equations is inaccurate and can overestimate kidney function. Hepato-renal syndrome (HRS) is a life-threatening disorder. In the last decade, there was significant progress in understanding the mechanism of this mysterious disorder. In this article, we are focusing on different mechanisms of kidney dysfunction in cirrhotic patients and the major diagnostic and therapeutic challenges.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79410805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portal hypertension occurs due to multiple disorders of the liver and its circulation. It is defined as an elevated pressure gradient between the portal circulation and the systemic circulation. The primary clinical consequences of portal hypertension are ascites and the development of portosystemic varices, which may cause life threatening hemorrhage. Modern management of portal hypertension includes medical, endoscopic therapy and transjugular intrahepatic portosystemic shunt placement by interventional radiology. Historically, portal hypertension was treated through the creation of surgical portosystemic shunts. In this chapter, the physiology of portal hypertension and the approaches to its management will be discussed. Specifically, the chapter will focus on indications, technical considerations, and types of surgical shunts used to treat portal hypertension, as well as literature supporting these procedures. Three case reports describing recent successful surgical shunt creation will be presented. Although portosystemic surgical shunt creation is performed far less frequently as medical, endoscopic and radiologic interventions have improved, this chapter illustrates that this procedure is a vital tool to be used in the treatment of portal hypertension.
{"title":"Portal Hypertension: Current Surgical Management","authors":"L. Wancata, Christopher R. Connelly, S. Orloff","doi":"10.1055/s-0042-1748021","DOIUrl":"https://doi.org/10.1055/s-0042-1748021","url":null,"abstract":"Portal hypertension occurs due to multiple disorders of the liver and its circulation. It is defined as an elevated pressure gradient between the portal circulation and the systemic circulation. The primary clinical consequences of portal hypertension are ascites and the development of portosystemic varices, which may cause life threatening hemorrhage. Modern management of portal hypertension includes medical, endoscopic therapy and transjugular intrahepatic portosystemic shunt placement by interventional radiology. Historically, portal hypertension was treated through the creation of surgical portosystemic shunts. In this chapter, the physiology of portal hypertension and the approaches to its management will be discussed. Specifically, the chapter will focus on indications, technical considerations, and types of surgical shunts used to treat portal hypertension, as well as literature supporting these procedures. Three case reports describing recent successful surgical shunt creation will be presented. Although portosystemic surgical shunt creation is performed far less frequently as medical, endoscopic and radiologic interventions have improved, this chapter illustrates that this procedure is a vital tool to be used in the treatment of portal hypertension.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79251122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Over 14 million colonoscopies are performed annually in the United States. With the growing number of colonoscopies comes corresponding increases in the rates of colectomies performed for benign polyps. These advanced adenomas have the potential, if removed early, to promote decreased rates of colon cancer and improve patient survival. Difficult to resect polyps may be located at colonic flexures, tortuous turns in the colon, the ileocecal valve, or the appendiceal orifice presenting a unique challenge to endoscopic resection. Various advanced endoscopic techniques are now available for the resection of these polyps such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection, but these techniques have a steep learning curve and are technically challenging. For the community colorectal surgeon, relatively simpler options include combined endoscopic and laparoscopic surgery (CELS) and full-thickness laparo-endoscopic colonic excision (FLEX) for either the endoscopic or laparoscopic removal of challenging polyps. The FLEX procedure resembled a nonanatomic wedge resection of the colon with polyp, while CELS resembles a laparoscopically augmented EMR. With the technical success rate for CELS reportedly between 74 and 97%, the postoperative complication rate of less than 5%, and polyp recurrence rates bordering less than 2%, these procedures have the capacity to safely facilitate the complete removal of difficult-to-resect endoscopic polyps. The purpose of this review is to both provide recommendations for CELS and FLEX utilization for the resection of polyps and describe our operative techniques and tips and tools for increasing the efficacy of these procedures.
{"title":"Combined Endoscopic–Laparoscopic Surgery (CELS) in the Management of Early Colorectal Lesions","authors":"J. Wlodarczyk, S. Lee","doi":"10.1055/s-0043-1760729","DOIUrl":"https://doi.org/10.1055/s-0043-1760729","url":null,"abstract":"Abstract Over 14 million colonoscopies are performed annually in the United States. With the growing number of colonoscopies comes corresponding increases in the rates of colectomies performed for benign polyps. These advanced adenomas have the potential, if removed early, to promote decreased rates of colon cancer and improve patient survival. Difficult to resect polyps may be located at colonic flexures, tortuous turns in the colon, the ileocecal valve, or the appendiceal orifice presenting a unique challenge to endoscopic resection. Various advanced endoscopic techniques are now available for the resection of these polyps such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection, but these techniques have a steep learning curve and are technically challenging. For the community colorectal surgeon, relatively simpler options include combined endoscopic and laparoscopic surgery (CELS) and full-thickness laparo-endoscopic colonic excision (FLEX) for either the endoscopic or laparoscopic removal of challenging polyps. The FLEX procedure resembled a nonanatomic wedge resection of the colon with polyp, while CELS resembles a laparoscopically augmented EMR. With the technical success rate for CELS reportedly between 74 and 97%, the postoperative complication rate of less than 5%, and polyp recurrence rates bordering less than 2%, these procedures have the capacity to safely facilitate the complete removal of difficult-to-resect endoscopic polyps. The purpose of this review is to both provide recommendations for CELS and FLEX utilization for the resection of polyps and describe our operative techniques and tips and tools for increasing the efficacy of these procedures.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"76 1","pages":"017 - 023"},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83830910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liver cirrhosis is a significant cause of morbidity and mortality and can result in alterations to cardiac function. Patients with cirrhosis may develop a hyperdynamic circulation. Furthermore, systolic or diastolic function may occur, although diastolic function is more common. The transjugular intraheptic portosystemic shunt (TIPS) is an increasingly prominent procedure to treat portal hypertension that can result in transient worsening of hyperdynamic circulation. TIPS can be complicated by cardiac decompensation, with diastolic dysfunction playing a key role. Investigators developed an algorithm to stratify risk of cardiac decompensation after TIPS using natriuretic peptide levels and echocardiography. Eighty percent of patients with aortic stenosis decompensated after TIPS in one cohort, but this requires further study before it is considered a contraindication. Cirrhosis has also been linked to development of atrial fibrillation, although data remain mixed. The first-choice anticoagulant should be direct oral anticoagulants, as studies show superior outcomes to warfarin. QTc prolongation is often seen in patients with cirrhosis, theoretically predisposing to ventricular arrhythmias, however the clinical significance remains unclear. The impact of TIPS on arrhythmia is understudied, but small cohorts found high rates. Overall, cirrhosis can have significant impacts of cardiac function and clinicians must be aware of these alterations.
{"title":"Cardiovascular Considerations in Patients with Liver Cirrhosis","authors":"Braden Vogt, Antony F. Chu","doi":"10.1055/s-0042-1745860","DOIUrl":"https://doi.org/10.1055/s-0042-1745860","url":null,"abstract":"Liver cirrhosis is a significant cause of morbidity and mortality and can result in alterations to cardiac function. Patients with cirrhosis may develop a hyperdynamic circulation. Furthermore, systolic or diastolic function may occur, although diastolic function is more common. The transjugular intraheptic portosystemic shunt (TIPS) is an increasingly prominent procedure to treat portal hypertension that can result in transient worsening of hyperdynamic circulation. TIPS can be complicated by cardiac decompensation, with diastolic dysfunction playing a key role. Investigators developed an algorithm to stratify risk of cardiac decompensation after TIPS using natriuretic peptide levels and echocardiography. Eighty percent of patients with aortic stenosis decompensated after TIPS in one cohort, but this requires further study before it is considered a contraindication. Cirrhosis has also been linked to development of atrial fibrillation, although data remain mixed. The first-choice anticoagulant should be direct oral anticoagulants, as studies show superior outcomes to warfarin. QTc prolongation is often seen in patients with cirrhosis, theoretically predisposing to ventricular arrhythmias, however the clinical significance remains unclear. The impact of TIPS on arrhythmia is understudied, but small cohorts found high rates. Overall, cirrhosis can have significant impacts of cardiac function and clinicians must be aware of these alterations.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80242667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justin Robbins, Sahaj Mujumdar, Danielle M. Tholey
Portal hypertension is a difficult to treat sequelae of end stage of liver disease, and is associated with a variety of complications. Notably, it can lead to significant gastrointestinal bleeding, which carries a high risk of mortality. Sources of portal hypertensive bleeding include esophageal and gastric varices, portal hypertensive gastropathy and ectopic varices. Fortunately, endoscopic techniques are effective in both prevention and management of acute bleeding, and their application and expansion has led to improved outcomes. Endoscopy plays a pivotal role as it allows for direct visualization and diagnosis as well as immediate intervention. There are several endoscopic techniques available for the treatment of esophageal varices including band ligation, glue therapy and sclerotherapy. There are, however, gray areas within the management of portal hypertensive bleeding such as the management of portal hypertensive gastropathy and gastric variceal bleeding, both of which can be more challenging to treat endoscopically. Thus, there is growing interest regarding how novel advanced therapeutic techniques can address these areas with a focus on endoscopic ultrasound guided therapies. This article will review both traditional and novel endoscopic techniques used in the management and prevention of portal hypertensive associated bleeding.
{"title":"Portal Hypertension and Current Endoscopic Management","authors":"Justin Robbins, Sahaj Mujumdar, Danielle M. Tholey","doi":"10.1055/s-0042-1745861","DOIUrl":"https://doi.org/10.1055/s-0042-1745861","url":null,"abstract":"Portal hypertension is a difficult to treat sequelae of end stage of liver disease, and is associated with a variety of complications. Notably, it can lead to significant gastrointestinal bleeding, which carries a high risk of mortality. Sources of portal hypertensive bleeding include esophageal and gastric varices, portal hypertensive gastropathy and ectopic varices. Fortunately, endoscopic techniques are effective in both prevention and management of acute bleeding, and their application and expansion has led to improved outcomes. Endoscopy plays a pivotal role as it allows for direct visualization and diagnosis as well as immediate intervention. There are several endoscopic techniques available for the treatment of esophageal varices including band ligation, glue therapy and sclerotherapy. There are, however, gray areas within the management of portal hypertensive bleeding such as the management of portal hypertensive gastropathy and gastric variceal bleeding, both of which can be more challenging to treat endoscopically. Thus, there is growing interest regarding how novel advanced therapeutic techniques can address these areas with a focus on endoscopic ultrasound guided therapies. This article will review both traditional and novel endoscopic techniques used in the management and prevention of portal hypertensive associated bleeding.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80507011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Maleux, W. Laleman, L. Bonne, P. Buyck, F. Nevens
Transjugular intrahepatic portosystemic shunt (TIPS) procedures may be complicated by hepatic encephalopathy related to excessive shunting of portal venous blood into the systemic circulation without detoxification by the liver parenchyma. Although liver transplantation is the only curative treatment option, only a few patients can benefit from this procedure. In a first step, medical, conservative management is performed. In case of hepatic encephalopathy, refractory to medical management, several interventional techniques are available to reduce the diameter of the TIPS and subsequently, to reduce the volume of shunted portal venous blood. Technical aspects, devices and outcome results of these reduction procedures will be discussed as well as preventive procedures and devices which can be used during initial TIPS procedures.
{"title":"Post-TIPS Hepatic Encephalopathy","authors":"G. Maleux, W. Laleman, L. Bonne, P. Buyck, F. Nevens","doi":"10.1055/s-0042-1746191","DOIUrl":"https://doi.org/10.1055/s-0042-1746191","url":null,"abstract":"Transjugular intrahepatic portosystemic shunt (TIPS) procedures may be complicated by hepatic encephalopathy related to excessive shunting of portal venous blood into the systemic circulation without detoxification by the liver parenchyma. Although liver transplantation is the only curative treatment option, only a few patients can benefit from this procedure. In a first step, medical, conservative management is performed. In case of hepatic encephalopathy, refractory to medical management, several interventional techniques are available to reduce the diameter of the TIPS and subsequently, to reduce the volume of shunted portal venous blood. Technical aspects, devices and outcome results of these reduction procedures will be discussed as well as preventive procedures and devices which can be used during initial TIPS procedures.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78965677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portal hypertension is a known cause of morbidity and mortality in children. With a paucity of data and no standardized algorithm for treatment, a comprehensive understanding of this disease process is necessary for pediatric interventional radiologists, hepatologists, and surgeons who collaborate to care for these patients. While associations can be drawn to adult disease, the specifics of pediatric portal hypertension necessitate a separate, multidisciplinary approach. This review provides a summary and update on the evaluation, management, and treatment of pediatric portal hypertension.
{"title":"Pediatric Portal Hypertension: Etiology and Management","authors":"Jay H. Shah, Harun Krndzija, C. Hawkins","doi":"10.1055/s-0042-1745857","DOIUrl":"https://doi.org/10.1055/s-0042-1745857","url":null,"abstract":"Portal hypertension is a known cause of morbidity and mortality in children. With a paucity of data and no standardized algorithm for treatment, a comprehensive understanding of this disease process is necessary for pediatric interventional radiologists, hepatologists, and surgeons who collaborate to care for these patients. While associations can be drawn to adult disease, the specifics of pediatric portal hypertension necessitate a separate, multidisciplinary approach. This review provides a summary and update on the evaluation, management, and treatment of pediatric portal hypertension.","PeriodicalId":91014,"journal":{"name":"Digestive disease interventions","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77239678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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